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• STATE ID NUMBER 00000012411002 <br /> ,! APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> [�) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ] 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> c ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPCRATION.INDZVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> THE SOUTHLAND CORPORATION ( ) 01 FED ( ) 02 STATE [ ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 5820 STONERIOGE MALL ROAD, #31 PLEASANTON CA 94566 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> 7-ELEVEN FOOD STORE 2243-20680 KENOELL & MARTHA MCFARLAND <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 9110 THORNTON ROAD WALDMAN <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95209 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 2937 VENEMAN ROAD MODESTO CA .95356 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-578-9716 (X) 01 GASOLINE STATION ( J 02 OTHER <br /> NUMBEP OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> 11I 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> TOM EFAW 209-578-9716 TOM EFAW 209-527-0870 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 20680-2 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1979 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( 7 05 WASTE OIL ( 106 OTHER <br /> �j4LCr hpr,j L Lcp To t_S 44�__ <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> S. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON—VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 103 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ] 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE f ) 10 NON—METALLIC <br /> t ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (.10/18/85) PAGE 1 <br />